- When receiving services in hospitals by non-specialized staff, rape survivors are at risk of receiving inadequate and unethical care. They may suffer long waiting periods in emergency rooms, and during treatment may not receive the full spectrum of treatment. Medical providers may not be sufficiently trained in collecting forensic evidence or in providing emotional support to the survivor.
- Sexual assault nurse examiner programs are those in which nurses are specifically trained to conduct sexual assault examinations and provide care. In general these programs are designed to emphasize quality of care for survivors. Nurses usually work from dedicated examining suites in hospitals, but some programmes cover several hospitals and thus the nurse travels and there may even be mobile examination facilities (Jewkes, 2006).
- Nurses are usually expected to provide both emergency medical care and facilitate access to on-going support services. They are specially trained through recognised and validated courses and are expected to provide comprehensive medical care. Some programmes have full-time staff and others operate with on-call systems (Jewkes, 2006).
- This model potentially has particular advantages for developing countries where doctors are often in short supply. Since the nurses give evidence in court it is essential that the legal system acknowledges the expertise of nurses and gives equal weight to this as it would to evidence of doctors (Jewkes, 2006).
Lesson Learned: Ensuring that trained nurses have the resources and support they need, especially in settings where the may have additional responsibilities beyond forensic nursing, is critical to the success of nurse examiner programs. Managers may not recognise that the needs of sexual violence health services should take precedence over those of other aspects of health care. This has been a particular problem in some settings outside North America.
Example: The Sexual Assault Nurse Examiner (SANE) forensics service has had positive results in the United States. A sexual assault nurse examiner is a registered nurse with an advanced education in the forensic examination of sexual assault survivors. Training in SANE, established by the International Association of Forensic Nurses, requires 40 hours of classroom learning and a clinical practicum of an additional 40 hours (Taylor, 2002).
Goals of SANE are to: protect the survivor from further harm; provide crises intervention; professional forensic collection, documentation and preservation of evidence; evaluate and treat sexually transmitted infections; evaluate pregnancy risk and offer prevention; assess, document and seek care for injuries; and appropriately refer survivors for immediate and follow-up medical care and follow-up counselling (Ledray, 1999). A SANE team may consist of a provider, police, and a rape advocate. Using the team approach, the survivor only has to tell the story once. Only the provider and counsellor should be present during the exam.
SANE patients in the United States experienced longer examinations and received higher quality of care as indicated by a greater percentage of completed physical exams and a greater percentage of completed evidence kits for prosecution (Derhammer et al., 2000, cited in Martin et al., 2007)
For comprehensive information on implementing a SANE program, see Sexual Assault Nurse Examiner (SANE) Development & Operations Guide (Ledray, L./Washington DC: Office for Victims of Crime, U.S. Department of Justice, 1999). Available in English.